Provider Demographics
NPI:1669941324
Name:INTEGRATIVE SPINE AND SPORTS CHIROPRACTIC REHAB PLLC
Entity type:Organization
Organization Name:INTEGRATIVE SPINE AND SPORTS CHIROPRACTIC REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PT
Authorized Official - Prefix:
Authorized Official - First Name:GERSHOM
Authorized Official - Middle Name:JINHYUN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:817-271-4877
Mailing Address - Street 1:8055 CAMBRIDGE ST APT 27
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3030
Mailing Address - Country:US
Mailing Address - Phone:832-350-5946
Mailing Address - Fax:
Practice Address - Street 1:500 SPRING HILL DR STE 120
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-6024
Practice Address - Country:US
Practice Address - Phone:832-413-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty